Objectives To assess the effects of exercise interventions for preventing falls in older people living in the community.
Selection criteria We included randomised controlled trials evaluating the effects of any form of exercise as a single intervention on falls in people aged 60+years living in the community.
Results Exercise reduces the rate of falls by 23% (rate ratio (RaR) 0.77, 95% CI 0.71 to 0.83; 12 981 participants, 59 studies; high-certainty evidence). Subgroup analyses showed no evidence of a difference in effect on falls on the basis of risk of falling as a trial inclusion criterion, participant age 75 years+ or group versus individual exercise but revealed a larger effect of exercise in trials where interventions were delivered by a health professional (usually a physiotherapist). Different forms of exercise had different impacts on falls. Compared with control, balance and functional exercises reduce the rate of falls by 24% (RaR 0.76, 95% CI 0.70 to 0.81; 7920 participants, 39 studies; high-certainty evidence). Multiple types of exercise (commonly balance and functional exercises plus resistance exercises) probably reduce the rate of falls by 34% (RaR 0.66, 95% CI 0.50 to 0.88; 1374 participants, 11 studies; moderate-certainty evidence). Tai Chi may reduce the rate of falls by 19% (RaR 0.81, 95% CI 0.67 to 0.99; 2655 participants, 7 studies; low-certainty evidence). We are uncertain of the effects of programmes that primarily involve resistance training, dance or walking.
Conclusions and implications Given the certainty of evidence, effective programmes should now be implemented.
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Contributors All authors have contributed to the production of this review. CS was involved in screening, data extraction, data analysis, co-led the writing of the review and acted as guarantor of the review. NJF was involved in screening, data extraction, data analysis and co-led the writing of the review. AT was involved in screening, data extraction, data analysis and contributed to writing the review. GW and ZAM were involved in screening, data extraction, data analysis and contributed to writing the review. KH was involved in data extraction, data analysis, contributed to writing the review and commented on drafts of the review. LC, SH and SL contributed to writing the review and commented on drafts of the review.
Funding This project was partly funded by the National Institute for Health Research (NIHR) via Cochrane Infrastructure funding to the Cochrane Bone, Joint and Muscle Trauma Group. Additional funding for the Cochrane Review was via the NIHR (UK): NIHR Cochrane Reviews of National Institute for Care and Excellence (NICE) Priority scheme, project reference: NIHR127512. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National. Authors CS and AT receive salary support from the Australian National Health and Medical Research Council.
Competing interests Several authors (CS, AT, SH, KH and SL) are currently running trials of fall prevention interventions; including the following ongoing trials in this review (ACTRN 12615000138583; ACTRN 12615000865516; ISRCTN71002650). These trials are all funded by national grant agencies. No review author was involved in study selection or processing of any trials in which they were or are involved. CS is an author of several trials considered in this review, including four included trials.21 22 23 24 25 NF has no known conflicts of interest. GW has no known conflicts of interest. AT has no known conflicts of interest. ZAM has no known conflicts of interest. KH is an author of several trials considered in this review, including one included trial.22 LC is an author of several trials considered in this review, including two included trials.26 27 SH has no known conflicts of interest. SL is lead author of the ProFaNE consensus for falls guidance and is an author of one of the trials considered in this review.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Author note This article is based on a Cochrane Review published in the Cochrane Database of Systematic Reviews (CDSR) 2019, Issue 1, DOI: 10.1002/14651858.CD012424.pub2. (see www.cochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the CDSR should be consulted for the most recent version of the review.
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